伴慢性背部疼痛SAPHO综合征患者全脊柱及骶髂关节MRI表现  

Whole spine and sacroiliac joint MRI findings in SAPHO syndrome patients with chronic back pain

作　　者：刘曦 徐文睿[1,4] 邵暇荔 李忱 张文[3] 张伟宏[1] LIU Xi;XU Wen-rui;SHAO Xia-li;LI Chen;ZHANG Wen;ZHANG Wei-hong(Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Traditional Chinese Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院放射科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院中医科,北京100730 [3]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,北京100730 [4]北京医院放射科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华临床免疫和变态反应杂志》2021年第2期159-165,共7页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的研究具有背部疼痛症状SAPHO综合征患者脊柱病变分布及MRI表现。方法对38例具有背部疼痛的SAPHO综合征患者进行全脊柱MRI+骶髂关节MRI检查,分析其病变分布特点及MRI特征。结果(1)38例患者中35例(92.1%)出现脊柱病变,23例(60.5%)出现骶髂关节病变,其中20例(52.6%)为脊柱和骶髂关节同时受累,3例(7.9%)仅见骶髂关节受累,15例(39.5%)仅见脊柱受累。35例患者的多发椎体受累,主要累及腰椎及第1骶椎。(2)每个病变椎体在四个椎角、椎板上下缘有不同程度的病变,受累椎体共出现567个病变,其中仅椎角受累占35.8%,椎角及附近终板受累占64.2%;病变在T1WI及T2WI序列显示混合信号占49.2%,脂肪信号为主占36.9%,骨髓水肿信号占13.9%,骨质硬化信号占46.9%,骨质侵蚀占50.6%。(3)共有310个椎体受累,其中80.3%受累椎体表现为连续性“kiss状”受累,其余为跳跃性受累;116个受累椎体邻近椎间盘狭窄;22个椎旁前纵韧带增厚;4个椎小关节受累。(4)骶髂关节受累见于23例患者,双侧受累占78.3%。58.5%以骶骨侧病变为著,14.6%出现关节强直,14.6%出现附近软组织增厚水肿。结论表现为背部疼痛的SAPHO综合征患者的病变以多椎体、连续性“kiss状”的受累方式为主。受累椎体附件、邻近椎间盘、椎旁韧带的受累程度较轻。骶髂关节病变多为双侧受累、以骶骨侧为著,较少出现关节强直。Objective To evaluated the lesion distribution patterns and MRI characteristics of patients with SAPHO syndrome who complained about back pain.Methods MRI examinations of the whole spine and sacroiliac joint(SIJ)were performed for 38 SAPHO patients with standardized protocols.We evaluated the lesion distribution patterns and MRI characteristics.Results(1)Of the 38 patients,35 patients(92.1%)had spinal lesions,23 patients(60.5%)had SIJ lesions,20 patients(52.6%)had both spinal and SIJ lesions,3 patients(7.9%)had SIJ lesions only,and 15 patients(39.5%)had spinal lesions only.The spinal lesions of the affected 35 patients mainly involved the lumbar and first sacral vertebrae.(2)Each affected vertebra showed abnormalities on the vertebral corners and the edges of the vertebral plate with varying degrees.A total of 567 lesions were found in the affected vertebrae,of which 35.8%presented on vertebral corners only,and 64.2%presented on both vertebral corners and nearby endplates.On T1WI and T2WI sequence,heterogeneous signal intensity was observed in 49.2%of the lesions,while fat deposition and bone marrow edema(BME)were observed in 36.9%and 13.9%of the lesions,respectively.Osteosclerosis were observed in 46.9%of the lesions,and bone erosion in 50.6%.(3)There were 310 vertebrae involved in total,of which 80.3%showed continuous“kiss-like”involvement,while the rest were separately involved.Intervertebral space was found narrow in 116 of affected vertebrae.Thickening of anterior longitudinal ligaments was observed adjacent to 22 affected vertebrae.Apophyseal joint was involved in 4 affected vertebrae.(4)23 subjects were affected by SIJ disorders,78.3%of which were bilaterally involved.Lesions distributed with a predilection on the sacrum in 58.5%of the affected joints.Ankylosis was observed in 14.6%of affected joints.Adjacent soft tissue was involved in 14.6%of affected joints.Conclusions The lesions of SAPHO patients with back pain demonstrated multiple-vertebral involvement with“kiss like”appearance.The adjacent

关 键 词：SAPHO综合征 脊柱 骶髂关节 MRI 

分 类 号：R68[医药卫生—骨科学]